You do not have to decline in order to receive Medicare coverage for care to maintain or slow declineToo often Medicare beneficiaries are told the care they are receiving to maintain their condition has to end and, if they decline, then they can … [Read more...] about Know Jimmo | You Do Not Have to Decline
Weekly Alert
Reports: Nursing Facilities’ “Financial Shenanigans” Divert Reimbursement to Private Gain, Jeopardizing Resident Care
In March 2024, two lengthy investigative pieces exposed the complex and often hidden ownership practices that increasingly dominate nursing facilities, evade meaningful public scrutiny and enforcement, and result in grossly poor care for … [Read more...] about Reports: Nursing Facilities’ “Financial Shenanigans” Divert Reimbursement to Private Gain, Jeopardizing Resident Care
A Model for Nursing Home Enforcement
Acting New Jersey Comptroller Kevin Walsh issued three reports identifying the worst-performing nursing facilities in the state and the millions of dollars these facilities receive in Medicaid funding, despite the poor care they provide to residents … [Read more...] about A Model for Nursing Home Enforcement
Good Progress in Litigation Against Medicare Drug Price Negotiations
In nine lawsuits filed across the country, the pharmaceutical industry is challenging the Medicare drug price negotiation program established by the Inflation Reduction Act (IRA). So far, the drug companies have not scored any victories, which means … [Read more...] about Good Progress in Litigation Against Medicare Drug Price Negotiations
KFF Report on Dual-Eligible Special Needs Plans (D-SNPs)
In 2021 almost 13 million people had health care through Medicare and Medicaid. These dual eligible individuals have the option of receiving care through Medicare Advantage plans for dual-eligible individuals, known as Dual-Eligible Special Needs … [Read more...] about KFF Report on Dual-Eligible Special Needs Plans (D-SNPs)
Know Jimmo | Why Skilled Maintenance Care Matters, In a Daughter’s Words
“These changes [from the Jimmo Settlement] are extremely meaningful, as my mother has repeatedly been denied the ability to continue the physical therapy she needs in order to prevent further deterioration of her condition. It has been … [Read more...] about Know Jimmo | Why Skilled Maintenance Care Matters, In a Daughter’s Words
Implementation of Medicare Drug Law Proceeds
Drug Industry Continues to Fight It; President Biden Proposes to Expand ItThe Inflation Reduction Act of 2022 (IRA), signed into law by President Biden on August 16, 2022, has already provided cost-savings for Medicare beneficiaries through … [Read more...] about Implementation of Medicare Drug Law Proceeds
Know Jimmo | CMS Reiterates that Medicare Coverage is Available to Maintain Function or Slow Decline
See MLN Connects Newsletter (2024-02-08-MLNC, 2/8/2024)“Medicare covers skilled nursing care and skilled therapy services under skilled nursing facility, home health, and outpatient therapy benefits when a beneficiary needs skilled care to … [Read more...] about Know Jimmo | CMS Reiterates that Medicare Coverage is Available to Maintain Function or Slow Decline
Update on Medicaid Unwinding from KFF
KFF’s Medicaid Enrollment and Unwinding Tracker provides information on Medicaid disenrollments, renewals, overall enrollment and other key indicators reported by states during the unwinding of the Medicaid continuous enrollment provision, which had … [Read more...] about Update on Medicaid Unwinding from KFF
Nursing Homes Hide Profits
Nursing homes claim to lose money every year, but they stay in business and don’t close or file for bankruptcy. How is that possible? It’s possible because industry claims aren’t true. Nursing homes hide 62.9% of profits by paying inflated prices to … [Read more...] about Nursing Homes Hide Profits